House File 2643 H-8304 Amend the amendment, H-8276, to House File 2643 as follows: 1 1. Page 13, after line 34 by inserting: 2 < DIVISION ___ 3 PREEXISTING CONDITIONS 4 Sec. ___. NEW SECTION . 514M.1 Short title. 5 This chapter shall be known and may be cited as “The Protect 6 Coverage for Preexisting Conditions Act” . 7 Sec. ___. NEW SECTION . 514M.2 Definitions. 8 As used in this chapter, unless the context otherwise 9 requires: 10 1. “Commissioner” means the commissioner of insurance. 11 2. “Health benefit plan” means any policy, contract, 12 certificate, or agreement, including a short-term, 13 limited-duration policy or a high deductible plan, offered or 14 issued by a health carrier to provide, deliver, arrange for, 15 pay for, or reimburse any of the costs of health care services. 16 3. “Health care services” means services for the diagnosis, 17 prevention, treatment, cure, or relief of a health condition, 18 illness, injury, or disease. 19 4. “Health carrier” means an entity subject to the 20 insurance laws and regulations of this state, or subject 21 to the jurisdiction of the commissioner, including an 22 insurance company offering sickness and accident plans, a 23 health maintenance organization, a nonprofit health service 24 corporation, a plan established pursuant to chapter 509A for 25 public employees, a plan offered or maintained by a multiple 26 employer welfare association, or any other entity providing 27 a plan of health insurance, health benefits, or health care 28 services. Notwithstanding section 505.20, subsection 1, “health 29 carrier” also includes a nonprofit agricultural organization 30 domiciled in the state that sponsors a health benefit plan 31 pursuant to section 505.20. 32 5. “Preexisting condition exclusion” means a limitation or 33 exclusion of benefits, or a denial of coverage, relating to 34 a condition based on the fact that the condition was present 35 -1- H8276.4456 (2) 88 ns/tm 1/ 10 #1.

before the date of enrollment for such coverage or the date 1 of denial of coverage, whether or not any medical advice, 2 diagnosis, care, or treatment was recommended or received for 3 the condition before the date of enrollment or the date of 4 denial of coverage. 5 Sec. ___. NEW SECTION . 514M.3 Preexisting conditions. 6 Notwithstanding any other provision of law to the contrary, 7 a health carrier that offers an individual health benefit plan 8 or a group health benefit plan in this state shall not do 9 either of the following: 10 1. Deny coverage to any employer or to any individual that 11 is eligible to apply for the individual health benefit plan or 12 the group health benefit plan. 13 2. Impose any preexisting condition exclusion on an 14 employer or on an individual with respect to the individual 15 health benefit plan or the group health benefit plan. 16 Sec. ___. NEW SECTION . 514M.4 Premium rates. 17 1. a. Notwithstanding any other provision of law to the 18 contrary, a health carrier that offers an individual health 19 benefit plan or a group health benefit plan in this state shall 20 develop premium rates for the individual health benefit plan 21 or the group health benefit plan based only on the following 22 factors: 23 (1) Age, except that the rate shall not vary by more than 24 three-to-one for like individuals of different ages who are age 25 twenty-one and older. 26 (2) Whether the health benefit plan covers an individual or 27 family. 28 (3) Tobacco use, except that the rate shall not vary by more 29 than one and one-half times the rate charged to a nontobacco 30 user. 31 (4) Geographic rating area established in compliance with 32 federal law. 33 b. Notwithstanding any other provision of law to the 34 contrary, with respect to premium rates for family coverage 35 -2- H8276.4456 (2) 88 ns/tm 2/ 10

under an individual health benefit plan or a group health 1 benefit plan offered in this state, a health carrier shall 2 apply the factors permitted pursuant to paragraph “a” based on 3 the premium that is attributable to each family member covered 4 under the health benefit plan in accordance with rules adopted 5 by the commissioner. 6 2. Notwithstanding any other provision of law to the 7 contrary, a health carrier that offers an individual health 8 benefit plan or a group health benefit plan in this state shall 9 adjust the premium rates established pursuant to subsection 1 10 no more frequently than annually and based only on the factors 11 in subsection 1, paragraph “a” , except that the health carrier 12 may adjust the premium rates in the following circumstances: 13 a. With respect to a small group health plan, if there are 14 changes in enrollment. 15 b. There is a change to the family composition of an 16 individual enrolled in an individual health benefit plan or of 17 an employee enrolled in a group health benefit plan. 18 c. There is a change in the geographic rating area or in 19 tobacco use for an individual enrolled in an individual health 20 benefit plan. 21 d. An individual enrolled in an individual health benefit 22 plan requests changes to the health benefit plan or a small 23 employer requests changes to a group health benefit plan. 24 e. A change in federal law or federal regulations requiring 25 a premium rate adjustment. 26 Sec. ___. NEW SECTION . 514M.5 Rules. 27 The commissioner shall adopt rules pursuant to chapter 17A 28 as necessary to implement and administer this chapter. 29 Sec. ___. NEW SECTION . 514M.6 Enforcement. 30 The commissioner shall take any action within the 31 commissioner’s authority to enforce compliance with this 32 chapter. 33 Sec. ___. APPLICABILITY. This division of this Act 34 applies to health benefit plans that are delivered, issued 35 -3- H8276.4456 (2) 88 ns/tm 3/ 10

for delivery, continued, or renewed in this state on or after 1 January 1, 2021. 2 DIVISION ___ 3 CHANGE EFFORTS PROHIBITED 4 Sec. ___. NEW SECTION . 135.192 Sexual orientation and 5 gender identity change efforts —— prohibitions —— penalties. 6 1. For the purposes of this section, unless the context 7 otherwise requires: 8 a. “Child” means an individual who is under the age of 18. 9 b. “Practitioner” means a physician and surgeon or 10 osteopathic physician and surgeon licensed under chapter 148 11 who specializes in the practice of psychiatry; a psychologist 12 licensed under chapter 154B; a licensed marital and family 13 therapist or mental health counselor or a temporary licensed 14 marital and family therapist or mental health counselor as 15 defined in section 154D.1; a social worker licensed pursuant to 16 chapter 154C; a licensed school counselor, school psychologist, 17 or school social worker; an advanced registered nurse 18 practitioner; a practitioner as defined in section 272.1; a 19 victim counselor as defined in section 915.20A; a psychiatric 20 nurse; any other person who provides counseling or mental 21 health or behavioral health services as a part of the person’s 22 professional training or practice under Iowa law or rule; or 23 any student, intern, volunteer, or other person assisting 24 or acting under the direction or guidance of any of these 25 professionals. 26 c. (1) “Sexual orientation or gender identity change 27 efforts” means any practice or treatment by a practitioner 28 that seeks to change an individual’s sexual orientation or 29 gender identity, including but not limited to efforts to change 30 behaviors or gender expressions, or to eliminate or reduce 31 sexual or romantic attractions or feelings toward individuals 32 of the same gender. 33 (2) “Sexual orientation or gender identity change efforts” 34 does not include any of the following practices, as long as the 35 -4- H8276.4456 (2) 88 ns/tm 4/ 10

practice does not seek to change sexual orientation or gender 1 identity: 2 (a) Counseling or therapy that provides acceptance, 3 support, and understanding of the individual or the 4 facilitation of an individual’s coping, social support, 5 and identity exploration and development, including sexual 6 orientation-neutral interventions to prevent or address 7 unlawful conduct or unsafe sexual practices. 8 (b) Counseling for an individual seeking to transition from 9 one gender to another. 10 2. A practitioner shall not engage in sexual orientation or 11 gender identity change efforts with a child. 12 3. A practitioner who engages in sexual orientation or 13 gender identity change efforts with a child shall be subject 14 to disciplinary action by the licensing entity or disciplinary 15 authority with professional jurisdiction over the practitioner. 16 Sec. ___. SEXUAL ORIENTATION AND GENDER IDENTITY CHANGE 17 EFFORTS —— CHILD FOSTER CARE —— MANDATORY REPORTERS —— RULES. 18 1. For the purposes of this section: 19 a. (1) “Child” means, as applicable, either a person less 20 than eighteen years of age or a person eighteen or nineteen 21 years of age who meets any of the following conditions: 22 (a) Is in full-time attendance at an accredited school 23 pursuing a course of study leading to a high school diploma. 24 (b) Is attending an instructional program leading to a high 25 school equivalency diploma. 26 (c) Has been identified by the director of special education 27 of the area education agency as a child requiring special 28 education as defined in section 256B.2, subsection 1. 29 (2) A person over eighteen years of age who has received a 30 high school diploma or a high school equivalency diploma is not 31 a “child” within the definition in this paragraph “a”. 32 b. “Mental injury” means the same as defined in section 33 232.2. 34 c. “Sexual orientation or gender identity change efforts” 35 -5- H8276.4456 (2) 88 ns/tm 5/ 10

means the same as defined in section 135.192. 1 2. The department of human services shall adopt rules 2 pursuant to chapter 17A relating to all of the following: 3 a. To prohibit, as a condition of licensure, an agency or 4 individual licensed pursuant to chapter 237 to provide child 5 foster care from participating in sexual orientation or gender 6 identity change efforts with a child for whom the licensed 7 agency or individual is providing child foster care. 8 b. To identify research-based instruction that supports 9 lesbian, gay, bisexual, transgender, and questioning youth, 10 including linguistic tools such as the correct use of pronouns 11 and names, for incorporation into necessary training for 12 department staff and for agencies or individuals licensed 13 pursuant to chapter 237 to provide child foster care. 14 c. To provide guidance to a mandatory reporter, as 15 enumerated in section 232.69, subsection 1, in associating 16 sexual orientation or gender identity change efforts with a 17 child with mental injury constituting child abuse pursuant to 18 section 232.68, subsection 2. 19 DIVISION ___ 20 STATE CONTRACTS —— IOWA PREFERENCE 21 Sec. ___. Section 8A.311, Code 2020, is amended by adding 22 the following new subsection: 23 NEW SUBSECTION . 12A. If the lowest responsive bid received 24 by the state for products or other purchases is from an 25 out-of-state business, and an Iowa-based business submitted a 26 bid which is within five percent or ten thousand dollars of 27 the price of the lowest bid, whichever is less, the Iowa-based 28 business which submitted the lowest responsive bid shall be 29 notified and shall be allowed to match the lowest bid before 30 a contract is awarded. 31 Sec. ___. NEW SECTION . 8F.6 Preference. 32 An oversight agency shall give preference in awarding a 33 service contract to a recipient entity under this chapter to 34 an Iowa-based business. 35 -6- H8276.4456 (2) 88 ns/tm 6/ 10

DIVISION ___ 1 PUBLIC RETIREMENT SYSTEMS GOALS 2 Sec. ___. Section 97D.1, Code 2020, is amended by adding the 3 following new subsection: 4 NEW SUBSECTION . 01. It is the intent of the general 5 assembly to maintain strong and stable public retirement 6 systems that allow employees to retire with dignity. 7 DIVISION ___ 8 GROUNDWATER PROTECTION FUND 9 Sec. ___. BULK TRANSPORT OF WATER. Of moneys available for 10 use by the department of natural resources from the groundwater 11 protection fund created in section 455E.11 for the fiscal year 12 beginning July 1, 2020, and ending June 30, 2021, which are 13 not allocated pursuant to that section, the department shall 14 support the protection of the state’s groundwater, including by 15 providing for administration; the prevention of the groundwater 16 extracted for bulk transport to another state for any purpose; 17 regulation and programs; salaries, support, maintenance, and 18 equipment; and miscellaneous purposes. 19 DIVISION ___ 20 UNITED STATES CLIMATE ALLIANCE 21 Sec. ___. NEW SECTION . 28O.1 United States Climate 22 Alliance. 23 The governor shall take all necessary actions for the state 24 to become a member of, participate in, and maintain membership 25 in the United States climate alliance. 26 DIVISION ___ 27 TELEHEALTH PARITY 28 Sec. ___. Section 514C.34, subsection 1, Code 2020, is 29 amended by adding the following new paragraphs: 30 NEW PARAGRAPH . 0a. “Covered person” means the same as 31 defined in section 514J.102. 32 NEW PARAGRAPH . 0c. “Health carrier” means the same as 33 defined in section 514J.102. 34 Sec. ___. Section 514C.34, Code 2020, is amended by adding 35 -7- H8276.4456 (2) 88 ns/tm 7/ 10

the following new subsection: 1 NEW SUBSECTION . 3A. A health carrier shall reimburse a 2 health care professional for health care services provided to 3 a covered person by telehealth on the same basis and at the 4 same rate as the health carrier would apply to the same health 5 care services provided to a covered person by the health care 6 professional in person. 7 Sec. ___. APPLICABILITY. This division of this Act applies 8 to health care services provided by a health care professional 9 to a covered person by telehealth on or after January 1, 2021. 10 DIVISION ___ 11 TAX CREDIT PROGRAM CAP 12 Sec. ___. NEW SECTION . 422.120 Tax credit programs —— 13 limitation. 14 1. Notwithstanding any other provision to the contrary, 15 moneys awarded under a tax credit program shall not exceed the 16 amount awarded during the fiscal year beginning July 1, 2019, 17 and ending June 30, 2020, in subsequent fiscal years. 18 2. If necessary for the administration of a tax credit 19 program, the tax credits may be awarded on a first-come, 20 first-served basis until the maximum amount allowable under 21 subsection 1 has been awarded. 22 3. This section does not apply to the tax programs subject 23 to limitation in section 15.119 or to the earned income tax 24 credit in section 422.12B. 25 DIVISION ___ 26 CORONAVIRUS RELIEF FUND —— MENTAL HEALTH AND DISABILITY 27 SERVICES 28 Sec. ___. CORONAVIRUS RELIEF FUND —— MENTAL HEALTH AND 29 DISABILITY SERVICES. Of the funds received by the state from 30 the federal coronavirus relief fund created pursuant to the 31 federal Coronavirus Aid, Relief, and Economic Security Act, 32 Pub. L. No. 116-136, $25,000,000 shall be deposited in the 33 mental health and disability regional services fund created 34 in section 225C.7A. Moneys deposited in the mental health 35 -8- H8276.4456 (2) 88 ns/tm 8/ 10

and disability regional services fund under this section 1 are appropriated to the department of human services for 2 distribution to the mental health and disability services 3 regions to fund mental health and disability services in 4 accordance with section 225C.7A. 5 DIVISION ___ 6 RESOURCE ENHANCEMENT AND PROTECTION 7 Sec. ___. Section 455A.18, subsection 3, paragraph a, Code 8 2020, is amended to read as follows: 9 a. For each fiscal year of the fiscal period beginning 10 July 1, 1997, and ending June 30, 2021 2031 , there is 11 appropriated from the general fund, to the Iowa resources 12 enhancement and protection fund, the amount of twenty million 13 dollars, to be used as provided in this chapter . However, 14 in any fiscal year of the fiscal period, if moneys from the 15 lottery are appropriated by the state to the fund, the amount 16 appropriated under this subsection shall be reduced by the 17 amount appropriated from the lottery. 18 DIVISION ___ 19 CORONAVIRUS RELIEF —— ESSENTIAL EMPLOYEES 20 Sec. ___. ESSENTIAL EMPLOYEES. Notwithstanding any 21 provision of law to the contrary, for purposes of any moneys 22 expended by the state from the federal coronavirus relief fund 23 created pursuant to the federal Coronavirus Aid, Relief, and 24 Economic Security Act, Pub. L. No. 116-136, persons employed 25 for purposes of childcare shall be considered essential 26 employees. 27 DIVISION ___ 28 CORONAVIRUS RELIEF —— SMALL BUSINESS GRANTS 29 Sec. ___. SMALL BUSINESS GRANTS. Notwithstanding any 30 provision of law to the contrary, for purposes of any moneys 31 expended by the state from the federal coronavirus relief fund 32 created pursuant to the federal Coronavirus Aid, Relief, and 33 Economic Security Act, Pub. L. No. 116-136, for small business 34 grants, nonprofit organizations are eligible to be awarded such 35 -9- H8276.4456 (2) 88 ns/tm 9/ 10

grants. 1 DIVISION ___ 2 TESTING SHORTAGE 3 Sec. ___. TESTING SHORTAGE. In the event a shortage 4 of tests for the novel coronavirus occurs in this state, 5 healthcare workers, members of vulnerable populations, and 6 those persons working with members of vulnerable populations 7 shall be given first preference to receive a test. > 8 2. By renumbering as necessary. 9 ______________________________ HALL of Woodbury -10- H8276.4456 (2) 88 ns/tm 10/ 10 #2.